Choosing the right medical scheme

With the ever-increasing medical costs - coupled with a wide variety of medical schemes and plan options - the medical scheme landscape can be extremely confusing and daunting for the consumer.

This environment has contributed to dwindling membership numbers and financial constraints, and medical schemes are now vigorously implementing strategies to attract additional members.

One of these strategies is to provide a number of cover options aimed at various income levels.

"Healthcare needs to be affordable and accessible, so it is important for medical aids to investigate ways of offering new affordable options to complement the existing product bouquets, which have traditionally targeted high and middle income earners," says Boysie Phehlukwayo of Gen-health.

lThe top-end "savings-style" product, the Cover Plus Plan, offers extensive benefits, as well as additional benefits once the savings have been depleted. It provides cover for 33 extra chronic benefits.

lThe Basic Cover Plan is an affordable option with comprehensive benefits. With this option, there are no financial limits for private hospitalisation and members can choose their own doctors, hospitals or specialists.

lThe newest offering, the Primary Cover Plan, is a highly affordable, income-based option available to groups. There are no financial limits and members can choose their doctors from a preferred supplier network.

To ensure that members benefit fully from their medical aid plans, Phehlukwayo says that schemes still need to a do a lot of work in terms of educating and enhancing communication with members.

"The Patient Health Charter states that patients have the right to a comprehensive knowledge of their medical aid benefits," he says.

"The onus is on medical schemes to assist and empower consumers by providing adequate advice, guidance and literature, enabling them to better manage and make the most of their cover.

"Gen-health addresses this issue by taking a partnership approach - helping our members make the best choices every step of the way."